How can you know that the patient you encounter at the scene of an emergency call has been poisoned? Family members or bystanders may, of course, report this fact when they call for help. There may be clues at the scene, such as empty pill bottles or containers of toxic substances, and the patient’s signs and symptoms may indicate poisoning or overdose.
Once on or in the body, poisons can do damage in a variety of ways. A poison may act as a corrosive or irritant, destroying skin and other body tissues.
Many are corrosives or irritants that will injure the skin and then be slowly absorbed into body tissues and the bloodstream, possibly causing widespread damage.
Carbon monoxide is one of the most common inhaled poisons, usually associated with motor-vehicle exhaust and fire suppression. The number of cases has increased recently because of the carbon monoxide that can accumulate from the use of improperly vented wood-burning stoves and the use of charcoal for heating and indoor cooking in areas without adequate ventilation.
In the case of inhaled poisoning, oxygen is a very important drug. Some inhaled poisons prevent the blood from transporting oxygen in the normal manner. Some prevent oxygen from getting into the bloodstream in the first place.
Contact with a variety of plant materials and certain forms of marine life can lead to skin damage and possible absorption into tissues under the skin.
Your care for the drug-abuse patient will be basically the same for all drugs and will not change unless you are so ordered by medical direction.
A traditional treatment for poisoning used to be syrup of ipecac. This orally administered drug causes vomiting in most people with just one dose. During recent years, however, it has been used less and less as the use of activated charcoal has increased.
Drug information final
Introduction ; It is the current, relevant, critically examined data about drug and drug use for given patient or situation. Many institutes run DIC(Drug Information Center) for the provision of drug information, to every group/kind of people from any place
First DIC was developed in University of Kentucky in 1960. In United states 80% of the Hospitals having DIC. Nepal, in infancy stage with a few centers. In Nepal DDA has started this type of services.
Need of drug information The no of drugs in the international market has increased very much The newer drugs are generally more potent & selective, and formulations becoming increasingly complex The literature on drugs has also expanded and covers a wide range of information To introduce a new drug into the practice, the professionals need to evaluate the given information. A simple,quick reference to a pharmacopoeia or formulary is no longer sufficient.
Aims and objectives of drug information services The provision of information to health professionals on specific problems related to the use of drugs in particular patients; The provision of information to officials in government agencies to optimize the decision making process; The preparation and development of guidelines and formularies; To improve patient compliance and to provide a guide to responsible self medication; To develop and participate in continuing education programs;
To participate in undergraduate and graduate teaching programs; To develop educational activities regarding the appropriate use of drugs for patients in the community; To prepare and distribute material on drugs to health personnel in the form of a drug Information bulletin and/or other media; To develop and participate in research programs;
The Sources of information/Resources availablePrimary Source: Information is presented by authors without any evaluation by a second party. Provides must current information about drugs. Examples; articles published in journals(eg British Medical Journal), thesis etc.Secondary source The original source has been evaluated by second party other than the publisher. Modified and rearranged form Examples; review articles like lexis-nexis, Medline etcTertiary source Information obtained from primary and secondary source and arranged in a manner to represent a composite of the available information. Examples; Representative form Pharmacopeias - BP, USP, IP, BNF etc., Encyclopedia Dictionaries Guides, text books
Other Sources:The DIC also receives information from The public and hospitals about the Adverse effects of any drug Local drug lists National Formularies Hospital Formularies Internet Phone calls to Manufacturers Government and Non-government organizations and also to other DIC’s.
Drug informer should understand the nature of the question and should ask all the needed questions to get the ultimate question Most specialists today use the modified systematic approach designed by ‘Host and Kirkwood’, these are;Step I ; Secure demographics of the requestors Who requests? Med/non med personnel Educated/un educated personnel Name/location/phone/email etc of requestorThis determines the type of response that will be givenStep II; Obtain background information Where the requestor heard/read about the drug? Is he/she taking medicine? Why? Is he/she a caregiver/wants to take medicine? This helps determining what additional information should be provided.
Step III; Determine and categorize the ultimate question Putting the pieces of information together to form ultimate question and once it has been determined, the next step is to categorize the question.Step IV;Develop strategy and conduct research Strategies should be developed with a typical algorithm with three essential components; tertiary-secondary-primary literatureStep V;Perform evaluation, analysis & synthesis Provider should take time to evaluate the info, analyze and then synthesize it into a good reply
Step VI;Formulate and provide response An outline should be established to help formulate a response to the drug info request. Its important to have; introduction, body and conclusionStep VII;Conduct follow-up and documentation Checking with the requestor to make sure his/her question has been sufficiently and completely answered. Of vital importance is to document all the steps taken in this process.
Among the skills of drug information is a knowledge of drug literature evaluation which allows one to provide a critical analysis of the literature and have a better understanding of the studies done in health and medicine. It is a key component to provide a good quality answer to a requester Being able to separate good data from poor data is essential Knowing the limitations of any study can help in evaluating the usability of its data Drug information specialists will often use some standard questions to help in this process Several references provide guides to evaluate the medical and pharmacy literature.
Do not guess Take several ethical issues into account ◦ Patient privacy must be maintained ◦ Patient-physician relation cannot be breached ◦ Response is not necessary if the inquirer intends to misuse or abuse the information that is provided.
Organize information before attempting to communicate the response to the inquirer. Tailor the response to the inquirer’s background. Tell the inquirer where the information was found. Alert the inquirer of a possible delay when it takes longer than anticipated to answer the question. Ask if the inquirer’s question is answered by the information.
Research the Facts, gather information(from the resources available i.e. tertiary- secondary- primary resources)about the question of oral report. List the facts and interesting information accurately. Remember that relevant details and vivid descriptions will make oral report more interesting Organize the Information/oral report in three parts. ◦ Introduction ◦ Body (main part) ◦ Conclusion Practice Giving the Oral Report Speak clearly and deliberately Make A Final Copy of Report Notes.
Drug information centers Drug information centers (DICs) in general, are service providers, which provide drug information relating to therapies, pharmacoeconomics, education, and research programs. It provides unbiased information to health care professionals and/or patients and consumers. Many centers also provide workshops or other forms of training to enhance the skills of healthcare professionals. A drug information center is usually a unit located within and/or affiliated with a larger organization (i.e., a pharmaceutical association, a hospital etc).
Pharmacist; specialists with proper knowledge of drug and actions associated with it with academic degree. ƒ(they provide drug information) Pharmacy Technicians & Students(they assist pharmacists in providing drug information like literature searching,retrieval of data,resources updating etc) People trained in library science with computer knowledge(they are supporting staffs in DIC for their own expertise) ƒ
The center should have specific hours of operation(24hrs preferably) and adequate technological resources (i.e., computers, phone lines, faxes, etc.) The drug information center should have the latest publications and ideally publish a newsletter or other informational updates.Role of Pharmacist: Must be a part of DIC,should be “ready to go” for information all the time. ‘The Drug-Information Pharmacist’ is at interface of vast amount knowledge on onside and the persons needing the knowledge on other. Should provide proper information irrespective of the
Drug Information Centers in NepalFour organizations in Kathmandu were initially identified as potential sites for drug information centers: Department of Drug Administration (DDA), Ministry of Health Drug Information Unit(DIU), Tribhuvan University Teaching Hospital Resource Centre for Primary Health Care (RECPHEC), a local non- governmental organization Nepal Chemists and Druggists Association (NCDA), a professional association for retailers and wholesalers A fifth organization, the Nepal Health Research Council(NHRC), also expressed an interest in establishing a drug information center. NHRC is a relatively new, quasi-governmental body whose mission is to review and approve all proposals for medical and health research to be conducted in Nepal.
Drug Information Network of Nepal (DINoN) The Drug Information Network of Nepal (DINoN) was established on 23rd September, 1996 with multi-sectoral participation including government, academic and non-government institutions to provide unbiased information on drugs to various constituency groups. A single organization may not have enough expertise, resources and capacity to satisfactorily meet the drug information needs of a wide range of target groups DINoN is an initiative to develop and disseminate information about the proper use of drugs, possible adverse reactions, contraindications, toxicity, drug standards and efficacy, precautions, and proper storage and handling to health care professionals in the public and private sector, and to consumers.
Founder members of DINoN DDA, Ministry of health and population Tribhuvan University Teaching Hospital, Drug Information Center Nepal Chemists and Druggists Association (NCDA) Resource Center for Primary Health Care (RECPHEC) Nepal Health Research Council (NHRC)Ordinary members of DINoN United Hands to Nepal Poison Information Center (UHN) Britain Nepal Medical Trust (BNMT) B.P. Koirala Institute of health Sciences (BPKIHS) Manipal College of Medical Sciences (MCOMS)
Note; The primary role of a DIC in a developing country is to give clear anddefinitive information on well-established essential drugs andpromote their rational use. A secondary role would be to keep up-to-date with pharmacological and therapeutic literature and to disseminate relevantinformation, as it becomes available.
Drug information bulletin It publishes the latest developments in medical sciences, the newly introduced drugs, new indication and other information regarding drugs. One of the PTCs duties is to assist the pharmacist in conducting a teaching program within the hospital through a pharmacy publication. The methods employed to disseminate interdepartmental information are usually bulletins, bulletin board notices and committee meetings. The bulletin normally publishes the latest development in the medical sciences, the newly introduced drugs, new indications for certain drugs, newer drug delivery systems, updates on drug interactions and ADRs. Pharmacist is normally held responsible for its publication however; contributions are obtained from pharmacists, physicians and nursing and other interested groups like therapeutic dietician for food drug interactions for publishing the bulletin. The contents should however be educative and informative.
PCC(Poison control center); For the provision of service regarding poison andrelated danger, and to manage with the poisoningCases Concept initiated in chicago in 1953PCC were established for two reasons: To provide rapid access to information valuable in assessing and treating poisonings. To assist with poisoning prevention
ƒPharmacy team pharmacist; specialists trained in poison information and in the management of poisoning emergencies. ƒ Pharmacy Technicians & Students ƒMedical team Toxicologists specializing in medical toxicology are also available for consultation.Supporting team People trained in library science with computer knowledge
◦ Assess and treatment recommendations during poisoning via 24-hour emergency telephone services◦ Provide public and professional educational programs◦ To collect data on poisonings◦ To perform research◦ Assist the public and health care providers during hazardous material spills
My daughter is 2 years old and just swallowed ½ a bottle of PCM… I just turned my heater on for the winter season and I am feeling light headed… I’m 72 years old and think I took a double dose of my medicine… I have a patient who swallowed …?
Exact name of the product involved (have the container close at hand) ƒ Amount of poison the person was exposed to ƒ Any symptoms ƒ Time of exposure Age and weight of the victim ƒ Any health problems the person has ƒ Any treatment that has been given ƒ Where the person is ƒ How the person was poisoned
Poison; Any substance that can harm the body by altering cell structure or functions Toxin; A poisonous substance secreted by bacteria, plants, or animals ◦ Examples: Mushrooms,Variety of plants, Bacterial contaminants in foodCommon Ingested Poisons Acetaminophen Acids and alkalis Antihistamines Food poisoning Insecticides Petroleum products Plants (cont.)
Important questions to consider askingpatient What substance? When did you ingest/become exposed? If an ingestion, how much did you ingest? Over what time period? What Interventions? How much do you weigh? [What effects are you experiencing from the ingestion?]
Poisons that are swallowed:◦ Household and industrial chemicals◦ Medications◦ Improperly prepared food◦ Plant materials◦ Petroleum products◦ Agricultural products
Ingested Poisons Signs and Symptoms Nausea,Vomiting,Diarrhea,Altered mental status, Abdominal pain,Chemical burns around the mouth, Different breath odors Emergency medical care •Remove from unsafe environment •Maintain airway and provide oxygen •Remove pills, tablets or fragments with gloves from patient’s mouth, as needed, without injuring oneself. •Consult medical direction •activated charcoal. •Bring all containers, bottles, labels, etc. of poison agents to receiving facility.
Be prepared for vomiting.Repeat vital signs.Dilution:Based on medical direction
Antidote—few and limitedPrevent absorption (charcoal).Supportive care (airway management, oxygenation,treatment of shock)Kidney dialysis
Poisons that are breathed in:◦ Gases: ammonia, chlorine◦ Vapors: carbon monoxide◦ Sprays: insecticides◦ Volatile liquid chemicals: change easily from liquid to gas G G A A S S
Fire suppression andmotor vehicle exhaustindoor cooking in areaswithout adequateventilatioColorless, odorless, andtasteless gasPrevents oxygenbinding with redblood cells
Inhaled Poison Signs and Symptoms Difficulty breathing ,Chest pain,Cough,Hoarseness,Dizziness, Headache,Confusion,Seizures,Altered mental status Emergency medical care Follow the chart
Poisons taken in through unbroken skin:◦ Corrosives or irritants◦ Through bloodstream◦ Insecticides and chemicals
Absorbed Poisons Signs and Symptoms Liquid or powder on the patient’s skin,Burns,Itching,Irritation,Redness Emergency medical care Skin--remove contaminated clothing while protecting oneself from contamination Powder--brush powder off patient, then continue as for other absorbed poisons. Liquid--irrigate with clean water for at least 20 minutes Eye--irrigate with clean water away from affected eye for at least 20 minutes
Powders—brush powder off. Liquids—irrigate with water for at least 20 min.
Toxic injection Signs and Symptoms Weakness,Dizziness,Chills,Fever,Nausea,Vomiting Emergency medical care Airway and oxygen Be alert for vomiting. Bring all containers, bottles labels, etc. of poison agents to receiving facility.
Alcohol and Substance Abuse Emergency medical care Establish and maintain a patent airway; Administer oxygen, as needed. If the patient is responsive, try to get him to sit or lie on a stretcher. Monitor the patient’s, mental status and vital signs frequently. Try to maintain proper body temperature Take measures to correct or prevent shock Protect from self-injury,Stay alert for seizures Transport
Perform an initial assessment.Provide oxygen and assist ventilations, if needed.Treat for shock.Perform rapid trauma assessment.Identify and treat life-threatening problems.Do focused history and physical exam.Assess baseline vital signs.Consult Medical Direction.Transport with all containers, bottles, and labels.Perform ongoing assessment. (cont.)
Indications:◦ Poisoning by mouthContraindications:◦ Altered mental status◦ Ingestion of acids or alkalis◦ Inability to swallowMedication form◦ Pre-mixed in plastic bottle (12.5 grams)◦ Powdered formDosage◦ Adults and children: 1 gram/kg Adult dose: 25–50 grams Pediatric dose: 12.5–25 gramsActions:◦ Binds to certain poisons◦ Reduces absorptionSide effects:◦ Black stools◦ Vomiting (cont.)
Syrup of Ipecac ◦ Not so used ◦ Reason for removal; It is said that it takes too long to cause vomiting and it does not remove enough of the poison from the stomach. ◦ Indications - poisoning by mouth